| Nicole Clay | |
|
3200 Greenfield Rd Ste 300 Dearborn MI 48120-1805 | |
| (313) 318-8208 | |
| Not Available |
| Full Name | Nicole Clay |
|---|---|
| Speciality | Counselor |
| Location | 3200 Greenfield Rd Ste 300, Dearborn, Michigan |
| Authorized Official Name and Position | Nicole Clay (PROFESSIONAL COUNSELOR/ OWNER) |
| Authorized Official Contact | 3133188208 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nicole Clay Po Box 442563 Detroit MI 48244-2563 Ph: (313) 318-8208 | Nicole Clay 3200 Greenfield Rd Ste 300 Dearborn MI 48120-1805 Ph: (313) 318-8208 |
| NPI Number | 1265067821 |
|---|---|
| Provider Enumeration Date | 03/04/2020 |
| Last Update Date | 05/31/2022 |
| Certification Date | 05/31/2022 |
| Medicare PECOS PAC ID | 8628456373 |
|---|---|
| Medicare Enrollment ID | O20220608001310 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265067821 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Lucinda Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104219823 PECOS PAC ID: 2961880612 Enrollment ID: I20220608001435 |
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